Aetna Medicare QMB Only Extra (HMO-POS D-SNP)
Available to residents of Litchfield County, CT for 2027. Contract H6303, plan 005, segment 0.
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
New for 2027. This plan has no 2026 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $12.10 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $12.10 |
| In-network out-of-pocket maximum | $9,850.00 |
| Drug deductible | $700.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO-POS D-SNP |
| Special needs plan | Dual-eligible SNP |
| D-SNP integration status | Coordination Only (CO) |
| Zero-dollar cost sharing D-SNP | Yes |
| Contract / plan | H6303-005-0 |
| Offered by | Aetna Medicare |
| Parent organization | CVS Health Corporation |
| Formulary tiers | 5 |
| Member services | (844)509-6254TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H6303 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $10.00 |
| Tier 3 · Preferred Brand | 22% |
| Tier 4 · Non-Preferred Drug | 25% |
| Tier 5 · Specialty Tier | 25% |
Also available in 7 other CT counties
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.